Manifestaciones oftalmológicas asociadas a la enfermedad por Coronavirus (COVID-19)

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 07-10-2022La infección por el coronavirus del síndrome respiratorio agudo severo 2 (SARS-CoV-2), responsable de la enfermedad por coronavirus 2019 (COVID-19), puede afectar a prácticamente todos los órganos, incluidos los ojos. Se ha detectado la presencia ARN de SARS-CoV-2 en lágrima y exudado conjuntival. También se han observado manifestaciones oculares tanto en el segmento anterior como en el segmento posterior, pudiendo aparecer tanto durante la fase aguda de la infección como tras la recuperación de la enfermedad. Además de estos cambios clínicos, se han observado cambios subclínicos en el grosor de las capas de la retina detectables mediante tomografía de coherencia óptica (OCT), y alteraciones en la circulación retiniana cuantificables mediante angiografía por OCT (OCTA). Objetivos: El objetivo principal de esta Tesis se centra en el estudio de la afectación oftalmológica de la COVID-19. Para ello, se ha estudiado la presencia de ARN de SARS-CoV-2 en lágrima y exudado conjuntival, las características clínicas y la frecuencia de la conjuntivitis, y la afectación del segmento posterior mediante exploración del fondo de ojo, OCT y OCTA en pacientes COVID-19...Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for coronavirus disease 2019 (COVID-19), may affect virtually all organs, including the eyes. SARS-CoV-2 RNA has been detected in tears and conjunctival swab. Ocular manifestations have also been observed in both the anterior and posterior segments and can appear both during the acute phase of infection and after recovery from the disease. In addition to these clinical changes, subclinical changes in the thickness of retinal layers detected by optical coherence tomography (OCT), and disturbances in retinal circulation measurable by OCT angiography (OCTA) have been observed. Objectives: The main objective of this Thesis focuses on the study of the ophthalmologic involvement of COVID-19. For this purpose, the presence of SARS-CoV-2 RNA in tear and conjunctival exudate, clinical features and frequency of conjunctivitis, and posterior segment involvement by fundus examination, OCT and OCTA in COVID-19 patients have been studied...Fac. de MedicinaTRUEunpu

Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctival Secretions: A Review

SARS-CoV-2 is a highly transmissible virus that spreads mainly via person-to-person contact through respiratory droplets, or through contact with contaminated objects or surfaces from an infected person. At present we are passing through a phase of slow and painful understanding of the origin, epidemiological profile, clinical spectrum, and risk profile of the virus. To the best of our knowledge there is only limited and contradictory evidence concerning SARS-CoV-2 transmission through other routes. Importantly, the eye may constitute not only a potential site of virus replication but also an alternative transmission route of the virus from the ocular surface to the respiratory and gastrointestinal tract. It is therefore imperative to gain a better insight into the potential ophthalmological transmission route of the virus and establish directions on best practice and future models of care for ophthalmological patients. This review article critically evaluates available evidence on the ophthalmological mode of viral transmission and the value of earlier identification of the virus on the eye. More evidence is urgently needed to better evaluate the need for protective measures and reliable ocular diagnostic tests to diminish further pandemic spread

Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma

The surgical management of glaucoma has been revolutionized by the introduction of minimally invasive glaucoma surgery (MIGS). The various MIGS options aim to meaningfully lower intraocular pressure with a better safety profile than traditional glaucoma surgery. The key clinical attributes and the emerging potential of an ab externo MicroShunt (PreserFlo™) are reviewed in the context of published evidence and clinical experience. This novel MicroShunt consists of an 8.5-mm-long tube that is implanted in the eye via an ab externo approach enabling aqueous humor drainage into the sub-Tenon's space through the formation of a bleb, similar in appearance to that created by trabeculectomy. The efficacy and safety of this procedure, the concomitant use of antimetabolites, the impact of tube positioning, and its future value in clinical practice are critically reviewed. Recent evidence has demonstrated the MicroShunt to be less effective than traditional filtration surgery, but with a significant improvement in safety. Cumulative data suggest that the new implant provides tangible clinical benefits to selected patients with glaucoma in need of further intraocular pressure (IOP) lowering. Future research should delineate the precise role of this and other MIGS options in the rapidly evolving glaucoma treatment algorithm.Unidad Docente de Inmunología, Oftalmología y ORLDepto. de Inmunología, Oftalmología y ORLFac. de Óptica y OptometríaFac. de MedicinaTRUEpu

Efectos y seguridad del perfluorohexiloctano en la superficie ocular y el endotelio corneal

Objetivo Evaluar los efectos y la seguridad del perfluorohexiloctano (F6H8) tópico en la superficie ocular y el endotelio corneal. Métodos Fueron diagnosticados 45 pacientes (90 ojos) de enfermedad de ojo seco, se seleccionaron y se les prescribió tratamiento con F6H8 durante 6 meses. Las variables en la tinción corneal se documentaron usando la escala National Eye Institute/Industry Workshop (NEI), las variables conjuntivales usando la escala Oxford y los parámetros corneales, como el espesor corneal central, la densidad celular, el coeficiente de variación, la hexagonalidad y el área celular promedio, al inicio del estudio, a los 3 meses y a los 6 meses. Se evaluó también el cumplimiento y la satisfacción. Resultados El tratamiento con F6H8 redujo la tinción corneal promedio en pacientes cumplidores a una media de -0, 84 ± 1, 95 a los 3 meses (p = 0, 001) y a -1, 65 ± 2, 42 a los 6 meses (p < 0, 001). La tinción conjuntival a los 6 meses mostró una disminución promedio de -0, 13 (p = 0, 319). Los parámetros endoteliales no mostraron diferencia significativa, excepto el espesor corneal central, que mostró una disminución estadísticamente significativa (era de 545, 30 ± 32, 25 µm al comienzo del estudio y 538, 40 ± 31, 36 µm tras 6 meses, p = 0, 009). Al final del estudio, el 46% de los pacientes informaron sentirse subjetivamente mejor, el 40, 5% no sintió cambios y el 13, 5% se sintió subjetivamente peor. Conclusiones El tratamiento tópico con F6H8 para la enfermedad de ojo seco no alteró las variables medidas del endotelio corneal, aunque sí mostró mejoría en la tinción corneal y en la satisfacción. Objective: To evaluate the effects and safety of topical drops of perfluorohexyloctane (F6H8) on the ocular surface and the corneal endothelium. Methods: Forty-five patients (90 eyes) diagnosed with dry eye disease were recruited and prescribed treatment with F6H8 as part of a six-month prospective multicentre study. Variables in corneal staining were documented using the National Eye Institute/Industry Workshop scale. The conjunctival variables included using the Oxford scale, as well as corneal parameters, such as central corneal thickness, cell density, coefficient of variation, hexagonality, and mean cell area, at the start of the study, and at 3 months and 6 months. Compliance and satisfaction with the treatment were measured. Results: F6H8 drops reduced mean corneal staining based on the NEI scale in compliant patients to a mean of -0.84 ± 1.95 at 3 months (P=.001) and to -1.65 ± 2.42 at 6 months (P<.001). Conjunctival staining at 6 months showed a mean decrease of -0.13 (P=.319). The endothelial parameters did not show a significant difference, in contrast to the central corneal thickness that showed a statistically significant decrease (545.30 ± 32.25 at the start of the study to 538.40 ± 31.36 after 6 months, P=.009). At the end of the study, 46% of patients reported feeling subjectively better, 40.5% felt the same, and 13.5% felt subjectively worse. Conclusions: Topical treatment with F6H8 for dried eye disease did not alter the measured variables of the corneal endothelium, but showed improvement in corneal staining and satisfaction

Hypercytokinemia in COVID-19: Tear cytokine profile in hospitalized COVID-19 patients

The aim of this study is to analyze the concentrations of cytokines in tear of hospitalized COVID-19 patients compared to healthy controls. Tear samples were obtained from 41 healthy controls and 62 COVID-19 patients. Twenty-seven cytokines were assessed: interleukin (IL)-1b, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL9, IL-10, IL-12, IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor basic, granulocyte colony-stimulating factor (G-CSF), granulocyte-monocyte colony-stimulating factor (GM-CSF), interferon (IFN)-γ, interferon gamma-induced protein, monocyte chemo-attractant protein-1, macrophage inflammatory protein (MIP)-1a, MIP-1b, platelet-derived growth factor (PDGF), regulated on activation normal T cell expressed and secreted, tumor necrosis factor-α and vascular endothelial growth factor (VEGF). In tear samples of COVID-19 patients, an increase in IL-9, IL-15, G-CSF, GM-CSF, IFN-γ, PDGF and VEGF was observed, along with a decrease in eotaxin compared to the control group (p < 0.05). A poor correlation between IL-6 levels in tear and blood was found. IL-1RA and GM-CSF were significantly lower in severe patients and those who needed treatment targeting the immune system (p < 0.05). Tear cytokine levels corroborate the inflammatory nature of SARS-CoV-2

Optic nerve and macular optical coherence tomography in recovered COVID-19 patients

Purpose: To investigate the peripapillary retinal nerve fiber layer thickness (RNFLT), macular RNFLT, ganglion cell layer (GCL), and inner plexiform layer (IPL) thickness in recovered COVID-19 patients compared to controls. Methods: Patients previously diagnosed with COVID-19 were included, while healthy patients formed the historic control group. All patients underwent an ophthalmological examination, including macular and optic nerve optical coherence tomography. In the case group, socio-demographic data, medical history, and neurological symptoms were collected. Results: One hundred sixty patients were included; 90 recovered COVID-19 patients and 70 controls. COVID-19 patients presented increases in global RNFLT (mean difference 4.3; CI95% 0.8 to 7.7), nasal superior (mean difference 6.9; CI95% 0.4 to 13.4), and nasal inferior (mean difference 10.2; CI95% 2.4 to 18.1) sectors of peripapillary RNFLT. Macular RNFL showed decreases in COVID-19 patients in volume (mean difference −0.05; CI95% −0.08 to −0.02), superior inner (mean difference −1.4; CI95% −2.5 to −0.4), nasal inner (mean difference −1.1; CI95% −1.8 to −0.3), and nasal outer (mean difference −4.7; CI95% −7.0 to −2.4) quadrants. COVID-19 patients presented increased GCL thickness in volume (mean difference 0.04; CI95% 0.01 to 0.07), superior outer (mean difference 2.1; CI95% 0.8 to 3.3), nasal outer (mean difference 2.5; CI95% 1.1 to 4.0), and inferior outer (mean difference1.2; CI95% 0.1 to 2.4) quadrants. COVID-19 patients with anosmia and ageusia presented an increase in peripapillary RNFLT and macular GCL compared to patients without these symptoms. Conclusions: SARS-CoV-2 may affect the optic nerve and cause changes in the retinal layers once the infection has resolved

Serpiginous Intraretinal Lesions Associated With Familial Exudative Vitreoretinopathy

Familial exudative vitreoretinopathy (FEVR) is a rare inherited disorder affecting retinal angiogenesis that may present with a wide range of phenotypic characteristics. In this report, the authors describe an atypical presentation of FEVR in a healthy 9-year-old male with progressive decreased visual acuity in the left eye. Fundus examination showed an avascular retina in the temporal periphery bilaterally. The left eye also revealed serpiginous hypopigmented lesions in the superior quadrant, which showed intraretinal location on optical coherence tomography and hyperautofluorescence. Genetic testing revealed LRP5 mutation, confirming a diagnosis of FEVR. The serpiginous lesions represent an unusual finding associated with FEVR not previously described in the literature. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:155–159.

Diferentes realidades asistenciales: un valor añadido en educación médica

Entre los objetivos importantes a alcanzar durante la formación de los estudiantes para el ejercicio de su actividad profesional en medicina está adquirir un concepto integral y holístico de la salud y comprender los principios de organización de los sistemas de salud en todos sus ámbitos asistenciales con sus condicionantes, incluyendo los organizativos y económicos. La figura del médico desde su etapa formativa debe integrar conocimientos y habilidades tanto técnicas como culturales que le permitan ejercer y comprender la salud en distintos ámbitos, contextos y sistemas sanitarios para adaptarse mejor a las diferentes situaciones laborales y sanitarias que se pueda encontrar. En la planificación de las prácticas clínicas de la primera promoción de estudiantes de tercero del Grado de Medicina de la Universidad Europea de Madrid se contó con Hospitales públicos y privados. Todos los alumnos durante el mismo curso recibieron clases teóricas, prácticas y seminarios por profesores pertenecientes a dos modelos hospitalarios. Se valoró la experiencia según la propia percepción de los alumnos teniendo en cuenta las encuestas de satisfacción con el profesorado y algunas herramientas de evaluación de las rotaciones clínicas propuestas en las asignaturas. En conjunto la valoración de los alumnos ha sido muy positiva.SIN FINANCIACIÓNNo data 2012UE